Highly active antiretroviral therapy (HAART) is increasingly available in Africa, lending urgency to the importance of helping patients adhere to these medications and to reduce secondary HIV-1 transmission, over time. Guidelines for incorporating secondary transmission risk reduction into HIV clinical care have not yet been adapted for providers in resource-poor settings. Nurses in these settings provide a substantial amount of HIV care, but often are not given specialized training. High-risk women are an epidemiologically important group at risk both for acquiring and transmitting HIV and sexually transmitted infections (STI) and would benefit from supportive interventions. The objective of this study is to improve adherence and promote sexual risk reduction among high-risk HIV-positive women on HAART. We will develop, pilot, and evaluate an integrated intervention involving: 1) a longitudinal study of peer-led group counseling and education materials (skill-building videotapes, graphical booklets and 2) clinical nurse training to enhance counseling skills to support HAART adherence, reduce sexual risk, and improve shared decision-making between providers and HIV-positive patients. Aim 1. Develop, pilot, and evaluate a group counseling intervention to support HAART adherence and transmission risk reduction among high-risk women in Mombasa, Kenya (n = 40). Assess intervention impact on a) HAART adherence (10% change in adherence [unreadable] by pill count, refill timing, single-item self-report, HIV-1 viral load, CD4 counts); and b) sexual risk (20% [unreadable] increase in correct and consistent condom use) outcomes before and immediately after the group delivery and at 3 months. We will collect STI incidence data (trichomoniasis, gonorrhea, syphilis). Aim 2. Develop, pilot, and disseminate a "Positive Prevention" curriculum for mid-level HIV providers (n = 100) holding a regional East Africa workshop and distributing materials via CD-ROM. Attendee knowledge, attitudes, and practices (KAP) will be evaluated before and immediately after and at 2 months. This study will increase behavioral science capacity and interchange between Kenyan HIV clinicians and researchers and the UW CFAR, thus adding value to the CFAR mission. Data will serve as pilot for a larger randomized controlled trial. This study's public health relevance is that it will help identify interventions for high-risk women in Kenya to reduce the development of HIV-1 viral resistance and secondary HIV-1 sexual transmission. [unreadable] [unreadable]